Postpartum computed tomography angiography of the fetoplacental macrovasculature in normal pregnancies and in those complicated by fetal growth restriction

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Abstract

INTRODUCTION: Current knowledge of the fetoplacental vasculature in fetal growth restriction (FGR) due to placental dysfunction focuses on the microvasculature rather than the macrovasculature. The aim of this study was to investigate the feasibility of computed topography angiography to analyze the fetoplacental macrovasculature in normal and FGR pregnancies.

MATERIAL AND METHODS: We included 29 placentas (22-42 weeks' gestation) from normal birthweight pregnancies and 8 placentas (26-37 weeks' gestation) from FGR pregnancies (birthweight < -15% and abnormal umbilical Doppler flow). We performed postpartum placental computed topography angiography followed by semi-automatic 3D image segmentation.

RESULTS: A median of 9 (range 7-11) vessel generations was identified. In normal birthweight placentas, gestational age was positively linearly correlated with macrovascular volume (p=0.002), vascular surface area (p<0.0005), and number of vessel junctions (p=0.012), but not with vessel diameter and inter-branch length. The FGR placentas had a lower weight (p=0.004) and smaller convex volume (p=0.022) (smallest convex volume containing the macrovasculature), however macrovascular volume was not significantly reduced. Hence, macrovascular density given as macrovascular outcomes per placental volume was increased in FGR placentas: macrovascular volume per convex volume (p=0.004), vascular surface area per convex volume (p=0.004), and number of vessel junctions per convex volume (p=0.037).

CONCLUSIONS: Evaluation of the fetoplacental macrovasculature is feasible with computed topography angiography. In normal birthweight placentas, macrovascular volume and surface area increased as pregnancy advances by vessel branching rather than increased vessel diameter and elongation. The FGR placenta was smaller; however the macrovascular volume was within normal range because of an increased macrovascular density. This article is protected by copyright. All rights reserved.

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Detaljer

INTRODUCTION: Current knowledge of the fetoplacental vasculature in fetal growth restriction (FGR) due to placental dysfunction focuses on the microvasculature rather than the macrovasculature. The aim of this study was to investigate the feasibility of computed topography angiography to analyze the fetoplacental macrovasculature in normal and FGR pregnancies.

MATERIAL AND METHODS: We included 29 placentas (22-42 weeks' gestation) from normal birthweight pregnancies and 8 placentas (26-37 weeks' gestation) from FGR pregnancies (birthweight < -15% and abnormal umbilical Doppler flow). We performed postpartum placental computed topography angiography followed by semi-automatic 3D image segmentation.

RESULTS: A median of 9 (range 7-11) vessel generations was identified. In normal birthweight placentas, gestational age was positively linearly correlated with macrovascular volume (p=0.002), vascular surface area (p<0.0005), and number of vessel junctions (p=0.012), but not with vessel diameter and inter-branch length. The FGR placentas had a lower weight (p=0.004) and smaller convex volume (p=0.022) (smallest convex volume containing the macrovasculature), however macrovascular volume was not significantly reduced. Hence, macrovascular density given as macrovascular outcomes per placental volume was increased in FGR placentas: macrovascular volume per convex volume (p=0.004), vascular surface area per convex volume (p=0.004), and number of vessel junctions per convex volume (p=0.037).

CONCLUSIONS: Evaluation of the fetoplacental macrovasculature is feasible with computed topography angiography. In normal birthweight placentas, macrovascular volume and surface area increased as pregnancy advances by vessel branching rather than increased vessel diameter and elongation. The FGR placenta was smaller; however the macrovascular volume was within normal range because of an increased macrovascular density. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftActa Obstetricia et Gynecologica Scandinavica
Volume/Bind97
Tidsskriftsnummer3
Sider (fra-til)322-329
ISSN0001-6349
DOI
StatusUdgivet - 2018
PublikationsartForskning
Peer reviewJa
ID: 267299092